Abstract
Thromboembolic complications following lower limb arthroplasty are reported to be high. The aim of this of this study is to ascertain the incidence of symptomatic venous thromboembolic disease following lower limb arthroplasty without Pharmacological thrombo prophylaxis.
Retrospective review was undertaken of 752 patients following total hip or total knee replacement between January 1st 2002 and June 30th 2005.
Fifty one patients were considered high risk and received thrombopharmacologal prophylaxis with Clexane and Warfarin. Information on all patients was obtained from medical records, computerised information system, general practitioners and patients themselves to produce a complete picture of the three months immediately following the index arthroplasty. All patients who presented with calf symptoms suggestive of venous thrombosis, respiratory distress or died in that three months were investigated.
Two patients were lost to follow up. All others had full documentation. Twenty-nine patients presented with calf related symptoms and after ultrasound investigation nine (five THR, four TKR) were confirmed to have venous thrombosis and were treated. One of these patients developed tense haemarthrosis while on treatment. Twelve other patients presented with respiratory symptoms. Eight (six THR two TKR) were confirmed to have pulmonary embolism on either VQ scan or spiral CT. Four of these on VQ scan were low probability. All patients were treated for thromboembolic disease and while on treatment one patient developed persistent wound discharge and infection. Of the 51 patients treated with pharmacological prophylaxis one developed a DVT and five developed wound problems, one of which was major. Two patients died during the three month period, but neither was related to thromboembolic disease.
From the 699 patients the symptomatic DVT rate was 1.1%. Symptomatic pulmonary embolism rate was 1.5% including the low probability of VQ scans. There was no mortality from thromboembolism in this study. These results compare favourably with the recent literature. Our department has a policy to select patients for thromboembolic prophylaxis based on high risk factors. All other patients are fully informed of this risk and are treated with elevation, avoidance of swelling, early supervised and regular mobilisation. Our result from this study substantiate our policy for selection of patients for thromboembolic prophylaxis.
Correspondence should be addressed to Associate Professor N. Susan Stott, Orthopaedic Department, Starship Children’s Hospital, Private Bag 92024, Auckland, New Zealand.
